Low-Value Care

The identification and removal of low-value care would result in immediate and substantial savings to create headroom for increased expenditures on high-value services.

Addressing Low-Value Care

The United States spends more, both per capita and as a percent of GDP, on health care than any other country, yet fails to achieve commensurate health outcomes. One reason for this discrepancy between health spending and outcomes is the significant amount – upwards of $200 billion per year – that the U.S. spends on low-value care.

Driven by human bias, information disparities, provider’s litigation concerns, and fee-for-service payment systems, low-value services provide no additional health benefit and, in some instances, may even be harmful to patients. With a pressing need to reduce costs and improve quality within the U.S. health care system, reducing the use of low-value services should be a priority for providers, purchasers, and patients.

Value-based insurance design improves health care quality and efficiency by reducing cost sharing for services that have strong evidence of clinical benefit. The same goals can also be accomplished by decreasing cost sharing for high-value services while increasing cost sharing for low-value services, ensuring more effective care and achieve net cost savings.

However, there are challenges in defining what is meant by “low-value services” and implementing programs to restrict such services’ use. Investments in processes to define low-value care, comparative effectiveness research to identify services that produce harm or marginal clinical benefit, and information technology to implement findings can facilitate applying value-based insurance design to the low-value realm that result in immediate and substantial savings.

Current Efforts

Previous efforts to identify, quantify, and reduce the use of low-value clinical services have beenmet with challenges. Campaigns such as the Choosing Wisely initiative have called upon health care providers to identify low-value services, but without corresponding action by purchasers and other stakeholders, progress has been slow. Building upon the lessons of the Choosing Wisely initiative, V-BID Health’s Task Force on Low-Value Care has identified a “Top-Five” list of low-value clinical services for purchasers to target for reduction. The selected services were chosen based on their association with harm, their cost, their prevalence, and the availability of concrete methods to reduce their use. The “Top-Five” include:

These services—chosen with the tenants of clinical nuance in mind—offer little to no clinical value, expose patients to unnecessary harm, and collectively contribute to over $25 billion annually in wasteful health spending. In going beyond identification to also offer concrete ways in which purchasers can work to eliminate the “Top Five,” this new V-BID Health initiative has the potential to catalyze meaningful change in the treatmentof low-value care and has garnered well-deserved support and attention – as showcased by recent articles in Health Affairs and The New York Times. Whether through alternative payment models, network design, or coverage policies, it’s time to take action against the financial and health burden of low-value care.